Provider Demographics
NPI:1306836176
Name:LUGO GUTIERREZ, FABIO H (MD)
Entity Type:Individual
Prefix:
First Name:FABIO
Middle Name:H
Last Name:LUGO GUTIERREZ
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:TORRE SAN CRISTOBAL
Mailing Address - Street 2:SUITE 309
Mailing Address - City:COTO LAUREL
Mailing Address - State:PR
Mailing Address - Zip Code:00780
Mailing Address - Country:US
Mailing Address - Phone:787-842-2594
Mailing Address - Fax:787-840-8821
Practice Address - Street 1:TORRE SAN CRISTOBAL
Practice Address - Street 2:SUITE 309
Practice Address - City:COTO LAUREL
Practice Address - State:PR
Practice Address - Zip Code:00780
Practice Address - Country:US
Practice Address - Phone:787-842-2594
Practice Address - Fax:787-840-8821
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2009-10-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR84422084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRE67621Medicare UPIN